Staff Recommendation CAMP COTUBIC Staff Recommendation Form You have been selected to be a reference for an individual applying for a position at Camp Cotubic. It is our desire to hire staff who help create an atmosphere where friends unite, fun excites, and youth meet Christ. Serious consideration will be given to your reference; there-fore we ask that you complete this form honestly to your best knowledge of the applicant. Your opinions and feedback are strictly confidential. Please return this form directly to Camp Cotubic by mail, fax, or email. If you have any questions or concerns, please contact Program Director Jason Kimmel via email (jsnkmml@gmail.com) or by phone at (937) 369-7420. Applicant Name* Recommender Information Recommender Name Recommender Organization Job Title/Position Held Phone Email Relationship How long have you known the applicant and in what capacity? How well do you know the applicant? Not very well Fairly Well Very Well Close Relationship How recent is your interaction with the applicant? More than six months since contact Occasional interaction in past year Consistent interaction in past year Regular contact Has the applicant made a personal commitment to follow Jesus Christ? Yes No Unknown If yes, is this commitment evidenced by his or her lifestyle? Yes No Unknown If necessary, please elaborate Does the applicant have any known history of: Alcohol/Tobacco Yes No Anorexia Nervosa or Bulimia Yes No Anxiety/Panic Attacks Yes No Attempted Suicide Yes No Homosexuality Yes No Does the applicant have any known past or present criminal record? Yes No If so, explain? Please check ALL qualities that describe the applicant’s WORK HABITS: Distracted easily Goes above and beyond Follows suggestions willingly Lazy Meets expectations Needs constant supervision Needs Prodding Neglects common good for own interests Procrastinates Resents suggestions Self-sufficient Teachable Takes initiative Unusual perseverance Other Please rate the applicant in the following areas: Adaptability Poor Below Average Average Above Average Excellent Not Sure Creativity Poor Below Average Average Above Average Excellent Not Sure Decision Making Poor Below Average Average Above Average Excellent Not Sure Dependability Poor Below Average Average Above Average Excellent Not Sure Discernment Poor Below Average Average Above Average Excellent Not Sure First Impression Poor Below Average Average Above Average Excellent Not Sure Health/Stamina Poor Below Average Average Above Average Excellent Not Sure Humility Poor Below Average Average Above Average Excellent Not Sure Integrity Poor Below Average Average Above Average Excellent Not Sure Moral Character Poor Below Average Average Above Average Excellent Not Sure Rapport With Kids Poor Below Average Average Above Average Excellent Not Sure Servant Heart Poor Below Average Average Above Average Excellent Not Sure Spiritual Maturity Poor Below Average Average Above Average Excellent Not Sure Team Participation Poor Below Average Average Above Average Excellent Not Sure Please check ALL qualities that describe the applicant’s PERSONALITY: Cold Encouraging Friendly Funny Likeable Loud Optimistic Overbearing Pessimistic Quiet Serious Withdrawn Other Please check ALL qualities that describe the applicant’s SOCIAL INTERACTION with peers and adults: Avoided by Others Creates Division Example for Others Goof Conversationalist Includer Liked by Others Manipulative Peacemaker Respected Shies away Sought out by others Tolerate by others Other Please check ALL qualities that describe the applicant’s EMOTIONAL STABILITY: Carefree Confident Listens to Others’ Needs Needy Often Overreacts Overly Insecure Relatively Stable Self-controlled Tends to be Moody Unstable Well-balanced Other Please check ALL qualities that describe the applicant’s LEADERSHIP STYLE/ABILITIES: Poor Ability Average Ability Good Ability Exceptional Ability Controls Dominant Follower Good Listener Motivational Natural Leader Servant Leader Wise Suggestions Other Please rate the presence of the following in the applicant: Anxiety Often Apparent Sometimes Apparent Rarely Apparent Never Apparent Not Sure Argumentativeness Often Apparent Sometimes Apparent Rarely Apparent Never Apparent Not Sure Critical Attitude Often Apparent Sometimes Apparent Rarely Apparent Never Apparent Not Sure Disrespect/Rebellion Often Apparent Sometimes Apparent Rarely Apparent Never Apparent Not Sure Poor Sportsmanship Often Apparent Sometimes Apparent Rarely Apparent Never Apparent Not Sure Please list two words that best describe the applicant: What is the applicant’s greatest strength? In what one area would you encourage the applicant to grow? Please explain: Who would benefit more from the applicant’s time at Cotubic, the applicant or the campers? Please explain: Would you feel comfortable leaving your own child in the care of the applicant? Yes No How do you recommend the applicant to work at Camp Cotubic? Highly recommend Recommend Do Not Recommend Recommend with Reservation Please Explain Is there any other information that you feel would be helpful to Camp Cotubic in considering the applicant for employment? Thank you for sharing your input regarding this applicant. By signing or typing your name on the line below, you certify that the information listed on this recommendation is true to the best of your knowledge. Signature* Date
